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To the Editor: The ALLHAT authors¹ do not comment on the curious finding that patients who received chlorthalidone were twice as likely as those assigned to amlodipine to die of unintentional injury, suicide, or homicide. Although the absolute difference in the risk (0.3 persons per 6-year per 100 persons) was small, it did reach statistical significance. The difference in the rate between chlorthalidone and lisinopril was in the same direction but did not reach statistical significance.

Although acknowledging that this end point was not prespecified, it nonetheless brings to mind the similar finding that patients treated with statins were at higher risk for suicide and violent behavior.² After further analysis, it seems that those associations were not causal in nature.³

Without wishing to detract from the evidence that initial use of a thiazide diuretic resulted in similar overall morality outcomes and indeed superior results in other outcomes, this intriguing finding . . . [Full Text of this Article]

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